July Fundraiser

Monday, July 9, 2012
8:00PM to 10:00PM

Manchester Pub
920 Second Avenue @ 49th Street
New York, NY 10017

Host Committee

Mara Blumenthal, Joseph Coe, Theodore Collins, Michael Corbett, Keith Dumanski, Dustin Hausner, Brian Hegt, Stephanie Elaine Hunt, Eric Katz, Leonard Kohen, Glenn Oldhoff, Christopher Ortiz, Amanda Pizzuti, Jesse Rose, Emil Skandul, Arthur Tang, Lawrence Tang, Ahmed Tigani, Jesse Towsen, Ben Yee (Listed Alphabetically)

Open Bar Well Drinks, Wine and Beer

$350      Host
$175      Sponsor
$100      Regular
$50        Young Professional
$25        Resident of Council District 5,
Young Democrats & Students

Credit Card Information
Enter numbers only, no spaces or dashes.
Security Code Location on Credit Card
Usually the last 3-4 digits in the signature area on the back of the card.
 
Billing Name and Address
Enter the name as shown on your credit or debit card, and the billing address for this card.
NYCCFB Campaign Finance Profile

To comply with New York City Campaign Finance Board reporting requirements, please provide the following information:

  I understand that State law requires that a contribution be in my name and be from my own funds. I hereby affirm that this contribution is being made from my personal funds, is not being reimbursed in any manner, and is not being made as a loan; in addition, in the case of a credit card contribution, I also hereby affirm that this contribution is being made from my personal credit card account, billed to and paid by me for my personal use, and has no corporate or business affiliation.
  If a contributor has business dealings with the City as defined in the Campaign Finance Act, such contributor may contribute only up to $250 for city council. If you are “doing business” with the City, please complete the following: